MEDICARE: ABIMBOLA OLUYEMISI OLUSANYA DNP, FNP, PMHNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	14059	CA
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	14059	CA

General Provider Information

NPI Number	:	1811958127
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ABIMBOLA OLUYEMISI OLUSANYA DNP, FNP, PMHNP-BC

Provider Business Mailing Address
First Line	:	3835 N FREEWAY BLVD STE 100
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95834-1954
Country	:	US
Telephone Number	:	916-576-7900
Fax Number	:

Provider Business Practice Location Address
First Line	:	9381 E STOCKTON BLVD STE 204
Second Line	:
City	:	ELK GROVE
State	:	CA
Zip	:	95624-5070
Country	:	US
Telephone Number	:	855-501-1004
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/28/2006
Last Update Date	:	04/08/2025

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